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1.
Texto & contexto enferm ; 29: e20180100, Jan.-Dec. 2020. tab
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1059131

RESUMO

ABSTRACT Objective: to evaluate the quality of life of nurses from the Mobile Emergency Care Service of the Federal District (Brazil) and to identify the domains that influenced this assessment. Method: an observational, descriptive, cross-sectional and quantitative study, with data obtained from 123 nurses who answered a questionnaire developed and structured in order to know sociodemographic and clinical variables and with the application of the World Health Organization Quality of Life Instrument Bref, to assess the quality of life. The data were submitted to descriptive statistics and inferential statics. Results: most of the nurses were women, aged between 20 and 40 years old, married, with a specialization degree and without any employment relation with another institution. Most (72.36%) considered their quality of life good or very good and were satisfied or very satisfied with their health (65.03%). The environment domain was the worst evaluated. A significant correlation was observed between the social relations (p=0.049) and environment (p=0.035) domains when correlated with the gender variable. The women rated their social relations and environment better than the men. Conclusion: the knowledge produced by this investigation may support the design of strategies that enable reducing the difficulties related to the life and work of nurses of the Mobile Emergency Care Service. Actions in this direction may contribute to the improvement of health, well-being and quality of life of the professionals and will have positive effects on the quality of health care provided to the population.


RESUMEN Objetivo: evaluar la calidad de vida de los enfermeros del Servicio de Atención Móvil de Emergencias del Distrito Federal (Brasil) e identificar los dominios que influenciaron en esa evaluación. Método: estudio de observación, descriptivo, transversal y cuantitativo, en el que se obtuvieron datos de 123 enfermeros que respondieron a un cuestionario desarrollado y estructurado para descubrir variables sociodemográficas y clínicas y en el que se aplicó el instrumento World Health Organization Quality of Life Instrument Bref para evaluar la calidad de vida. Los datos se sometieron a estadística descriptiva y inferencial. Resultados: en su mayoría, los enfermeros eran mujeres de 20 a 40 años de edad, casadas, con un nivel académico de especialización y sin ningún vínculo de empleo con otras instituciones. La mayor parte (72,36%) consideraron que su calidad de vida era buena o muy buena y se mostraron satisfechas o muy satisfechas con su salud (65,03%). El dominio del medio ambiente fue el peor evaluado. Se observó una correlación significativa entre los dominios de las relaciones sociales (p=0,049) y del medio ambiente (p=0,035) al correlacionarlos con la variable del sexo. Las mujeres evaluaron mejor que los hombres sus relaciones sociales y el medio ambiente. Conclusión: los conocimientos obtenidos gracias a esta investigación podrán ayudar a delinear estrategias que permitan reducir las dificultades relacionadas con la vida y el trabajo de los enfermeros del Servicio de Atención Móvil de Emergencias. Implementar acciones en este sentido podrá contribuir a mejorar la salud, el bienestar y la calidad de vida de los profesionales y tendrá efectos positivos sobre la calidad de la atención a la salud que se presta a la población.


RESUMO Objetivo: avaliar a qualidade de vida de enfermeiros do Serviço de Atendimento Móvel de Urgência do Distrito Federal (Brasil) e identificar os domínios que influenciaram nessa avaliação. Método: estudo observacional, descritivo, transversal e quantitativo, com dados obtidos de 123 enfermeiros que responderam a um questionário desenvolvido e estruturado para conhecer variáveis sociodemográficas e clínicas e com aplicação do World Health Organization Quality of Life Instrument Bref, para avaliar a qualidade de vida. Os dados foram submetidos à estatística descritiva e inferencial. Resultados: os enfermeiros eram em sua maioria mulheres, entre 20 a 40 anos, casadas, com nível acadêmico de especialização e sem vínculo empregatício com outra instituição. A maior parte (72,36%) considerou sua qualidade de vida boa ou muito boa e estava satisfeita ou muito satisfeita com a saúde (65,03%). O domínio meio ambiente foi o pior avaliado. Observou-se correlação significativa entre os domínios relações sociais (p=0,049) e meio ambiente (p=0,035) quando correlacionados à variável sexo. As mulheres avaliaram melhor suas relações sociais e o meio ambiente em relação aos homens. Conclusão: o conhecimento produzido por essa investigação poderá subsidiar o delineamento de estratégias que permitam diminuir as dificuldades relacionadas à vida e ao trabalho de enfermeiros do Serviço de Atendimento Móvel de Urgência. Ações nesse sentido poderão contribuir para a melhoria da saúde, do bem-estar e da qualidade de vida dos profissionais e terão efeitos positivos sobre a qualidade da assistência à saúde prestada à população.


Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Enfermagem , Serviços Médicos de Emergência , Qualidade de Vida , Organização Mundial da Saúde , Sistema Único de Saúde , Observação , Serviços de Atendimento , Serviços Médicos de Emergência , Enfermeiras e Enfermeiros
2.
Rev. latinoam. cienc. soc. niñez juv ; 18(2): 45-71, jul.-dic. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1144712

RESUMO

Resumen (analítico) Basado en un trabajo de campo etnográfico -de observación participante y entrevistas en profundidad- el artículo aborda las trayectorias educativas de los/as jóvenes peruanos/as que residen en dos barrios periféricos de la ciudad de Córdoba, Argentina. Además de describir y analizar las diferentes experiencias vinculadas a la educación en la ciudad, indaga -desde una perspectiva interseccional- la manera en que los proyectos migratorios familiares y las expectativas educativas de los adultos se articulan y tensionan con los proyectos educativos de los hijos y las hijas. Los resultados muestran que, a pesar de las expectativas de las familias en torno a la educación básica y universitaria en Argentina, las y los jóvenes se topan con dificultades concretas. Así, padres, madres, hijos e hijas despliegan un conjunto de estrategias para tratar de sostener ese proyecto educativo.


Abstract (analytical) The following article details a research study that uses an ethnographic method based on in-depth interviews and participant observation to examine the educational trajectories of young Peruvians who live in two peripheral neighborhoods of the city of Córdoba, Argentina. In addition to describing and analyzing their different experiences of education in the city, the study uses an intersectional perspective to identify how family migratory projects and educational expectations of parents are articulated and are in conflict with the educational projects defined by their children. The results show that despite the expectations of families in terms of basic and university education in Argentina, young people face specific difficulties in continuing with their educational trajectories. To address this, parents and children use a range of strategies to sustain these trajectories.


Resumo (analítico): Baseado em um trabalho de campo etnográfico -de entrevistas aprofundadas e observação participante - o artigo aborda as trajetórias educativas de jovens peruanos que redisem em dois bairros periféricos da cidade de Córdoba, Argentina. Além de descrever e analisar as diferentes experiências relacionadas à educação na cidade, questiona- desde uma perspectiva intersetorial - a maneira na qual os projetos migratórios familiares e as expectativas educacionais dos adultos são articulados e enfatizados nos projetos educacionais dos mais jovens. Os resultados mostram que, apesar das expectativas das famílias em relação à educação básica e universitária na Argentina, os jovens encontram dificuldades específicas. Assim pais, mães e filhos desenvolvem um conjunto de estratégias para tentar sustentar o projeto educacional.


Assuntos
Pais , Educação , Mães , Observação
3.
Rev. latinoam. cienc. soc. niñez juv ; 18(2): 169-198, jul.-dic. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1144717

RESUMO

Resumen (analítico) El artículo analiza las construcciones de juventud presentes en la Acción Católica Argentina y sus vínculos con trayectorias de jóvenes militantes insertos en parroquias del Gran Buenos Aires. Para el abordaje metodológico cualitativo se utilizan los siguientes materiales de campo, producidos entre 2016 y 2018: entrevistas en profundidad realizadas a jóvenes católicos, registros de observación participante en parroquias y eventos nacionales de Acción Católica Argentina y análisis de documentos institucionales. Dentro de la Acción Católica Argentina, se identifican tensiones entre las definiciones de juventud producidas por la institución y las trayectorias juveniles. Los jóvenes experimentan modos de «ser¼ y de «vivir¼ la juventud distintos a los propuestos por la Acción Católica Argentina, acordes con los cambios sociales y culturales que se produjeron en Argentina en las últimas décadas.


Abstract (analytical) This article analyzes the constructions of youth produced in the Acción Católica Argentina (Argentinian Catholic Action) organization and their link with the trajectories of militant youth living in parishes of Gran Buenos Aires. Field materials produced between 2016 and 2018 are analyzed using a qualitative methodological approach that consists of: in-depth interviews with Catholic youth; participant observation records from parish and national Argentinian Catholic Action events; and the analysis of institutional documents. In Argentinian Catholic Action, tensions were identified between the definitions of youth produced by the institution and young people's own trajectories. Young people experience ways of «being¼ and «living¼ that are different from those proposed by the Argentinian Catholic Action and that respond to the social and cultural changes produced in Argentine society in recent decades.


Resumo (analítico) O artigo analisa as construções de jovens presentes na Acción Católica Argentina seus vínculos com as trajetórias de jovens militantes inseridos nas paróquias da Gran Buenos Aires. Para a abordagem metodológica qualitativo, são utilizados materiais de campo produzidos entre 2016 e 2018, que consistem em entrevistas em profundidade com jovens católicos; registros de observação participante nas paróquias e eventos nacionais da Acción Católica Argentina e análise de documentos institucionais. Na Acción Católica Argentina, são identificadas tensões entre as definições de juventude produzidas pela instituição e as trajetórias da juventude. Os jovens experimentam maneiras de «ser¼ e «viver¼ a juventude diferentes dos propostos pela Acción Católica Argentina de acordo com as mudanças sociais e culturais produzidas na Argentina nas últimas décadas.


Assuntos
Catolicismo , Observação
4.
J Interprof Care ; 34(5): 614-621, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935607

RESUMO

The COVID-19 pandemic was declared by the World Health Organization on 11 March 2020. The rapid spread of SARS-CoV-2 required an equally rapid response from health-care organizations to find innovative ways to utilize the existing workforce to care for people with COVID-19. Using an evaluative case study, a unique insight into the collaborative allied health and nursing professions' response to COVID-19 at a specialist cardiothoracic hospital in the United Kingdom is presented. The aim of the case study was to evaluate how an interprofessional workforce from the wider organization could be supported to work in critical care as part of a crisis response. In identifying the key enablers to setting up an interprofessional Essential Care Team and learning from the lived experiences of those involved, this case study has demonstrated that, in supported, interprofessional teams the wider organizational workforce can be facilitated to effectively and safely provide critical care services. The lessons learned from this study will support future pandemic responses and aid the identification of further opportunities for interprofessional learning and practice. Ultimately, the study highlights that by identifying and investing in the key enablers, health-care organizations can be better prepared to respond to a global crisis.


Assuntos
Pessoal Técnico de Saúde , Comportamento Cooperativo , Infecções por Coronavirus/enfermagem , Cuidados de Enfermagem , Assistência Centrada no Paciente/organização & administração , Pneumonia Viral/enfermagem , Betacoronavirus , Humanos , Observação , Estudos de Casos Organizacionais , Pandemias , Equipe de Assistência ao Paciente , Reino Unido
5.
Soins Pediatr Pueric ; 41(314): 30-32, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32771205

RESUMO

Observation, better than any other tool, provides a more detailed understanding of the situation for a child and his parents, whatever the context in which the meeting takes place. However, if observation has fundamental virtues, it needs to be learned and taught. This is done through patient and rigorous learning throughout the professional career of a paediatric nurse.


Assuntos
Competência Clínica , Enfermeiras Pediátricas , Observação , Criança , Previsões , Humanos
6.
Br J Radiol ; 93(1114): 20190968, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32762545

RESUMO

OBJECTIVE: The study aimed to validate admission clinical and radiographic features of pediatric patients with traumatic epidural hematoma (EDH) that lead to safe observation. METHODS: A Level I trauma center radiology and electronic medical record databases were retrospectively queried for pediatric patients with EDH on CT scan between 1/1/2016 and 10/1/2016. Patient imaging, treatment and outcome variables were abstracted. Characteristics of the cohort were compared to an external cohort used to develop prediction rules for surgical intervention. External validity of the prediction rules was assessed. RESULTS: 195 eligible subjects were included in the study, 37 of which failed observation and required surgery while 158 underwent successful observation. The surgical cohort had significantly thicker (p < .001) and higher volume (p < .001) EDH, increased midline shift (p < .001) and higher likelihood of mass effect (p < .001). There was significantly higher residual neurologic deficit rate (54% vs 23%, p < .001) and hospital mortality (5% vs 0%, p = .035) amongst the surgical group. There were significant differences in patient demographic, clinical and imaging characteristics between the internal and external cohorts. The predictive rules externally developed yielded positive predictive value of 97.7% (95% CI = 93.3-99.5%), negative predictive value of 24.5% (95% CI = 16.2-34.4%), specificity of 88.5% (95% CI = 69.9-97.6%), and sensitivity of 63.8% (95% CI = 56.6-70.5%) for successful observation. CONCLUSION: The current study validates previously developed prediction rules for safe observation of pediatric EDH in a cohort with distinct characteristics from the external cohort. Specifically, patients with no mass effect, EDH volume <15 ml and no neurological deficits are less likely to fail observation. ADVANCES IN KNOWLEDGE: The current study validates prediction rules for safe observation of pediatric EDH in a distinct pediatric cohort that provides further support to conservative management in these circumstances.


Assuntos
Tratamento Conservador , Hematoma Epidural Craniano/diagnóstico por imagem , Hematoma Epidural Craniano/terapia , Observação , Tomografia Computadorizada por Raios X , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Centros de Traumatologia , Estados Unidos
7.
J Interprof Care ; 34(5): 600-606, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32718262

RESUMO

The COVID-19 pandemic, and ensuing physical distancing measures, poses challenges for researchers in the field of interprofessional care. Pandemic management has highlighted the centrality of interprofessional working to effective healthcare delivery during crises. It is essential to find ways to maintain interprofessional research that has commenced, while also designing research to capture important learning from pandemic management and response. However, it also creates opportunities for new research projects and novel research designs. This discussion paper explores ways of adapting existing research methodologies and outlines potential avenues for new research. Specifically, considerations to bear in mind when designing interprofessional research during the pandemic include research ethics and integrity, research design, data collection methods, research opportunities, implications and limitations. Interprofessional research can continue to make a valuable contribution in informing global responses to COVID-19 and in planning for future global health crises. We call for, insofar as possible, for interprofessional research to continue to be developed during this time.


Assuntos
Pesquisa Biomédica , Infecções por Coronavirus , Comunicação Interdisciplinar , Pandemias , Pneumonia Viral , Assistência à Saúde/organização & administração , Bolsas de Estudo , Grupos Focais , Humanos , Entrevistas como Assunto , Observação , Pandemias/prevenção & controle , Pesquisa Qualitativa , Síndrome Respiratória Aguda Grave
8.
Neuron ; 107(2): 351-367.e19, 2020 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-32433908

RESUMO

To advance the measurement of distributed neuronal population representations of targeted motor actions on single trials, we developed an optical method (COSMOS) for tracking neural activity in a largely uncharacterized spatiotemporal regime. COSMOS allowed simultaneous recording of neural dynamics at ∼30 Hz from over a thousand near-cellular resolution neuronal sources spread across the entire dorsal neocortex of awake, behaving mice during a three-option lick-to-target task. We identified spatially distributed neuronal population representations spanning the dorsal cortex that precisely encoded ongoing motor actions on single trials. Neuronal correlations measured at video rate using unaveraged, whole-session data had localized spatial structure, whereas trial-averaged data exhibited widespread correlations. Separable modes of neural activity encoded history-guided motor plans, with similar population dynamics in individual areas throughout cortex. These initial experiments illustrate how COSMOS enables investigation of large-scale cortical dynamics and that information about motor actions is widely shared between areas, potentially underlying distributed computations.


Assuntos
Córtex Cerebral/fisiologia , Neuroimagem/instrumentação , Neuroimagem/métodos , Observação/métodos , Algoritmos , Animais , Comportamento Animal/fisiologia , Mapeamento Encefálico , Condicionamento Operante , Craniotomia , Camundongos , Neocórtex/citologia , Neocórtex/fisiologia , Neurônios , Optogenética/métodos , Desempenho Psicomotor , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodos , Razão Sinal-Ruído
9.
Cuad. psicol. deporte ; 20(2): 112-127, mayo 2020. tab
Artigo em Português | IBECS | ID: ibc-ET5-1364

RESUMO

O presente estudo teve como principal objetivo desenvolver e validar um Sistema de Observação do Clima de Aula em Aulas de Grupo de Fitness (SOCA-AGF) bem como realizar uma aplicação piloto do mesmo. Participaram no estudo 6 instrutoras de 2 atividades (hidroginástica e localizada), em população idosa, para testar a funcionalidade do instrumento. Verificou-se que o SOCA-AGF, constituído por 2 dimensões, 36 categorias e 8 subcategorias, apresentou fiabilidade e validade. Os resultados obtidos indicam que o comportamento observável dos instrutores de fitness, em aulas de grupo, poderá ser codificado recorrendo a este instrumento. Concluiu-se que o SOCA-AGF regista aspetos fundamentais do comportamento que influencia o clima de aula dos instrutores de fitness em aulas de grupo e, como tal, poderá ser utilizado para estudar aspetos relevantes no âmbito do comportamento que influencia o clima de aula em diferentes atividades de grupo, no contexto do fitness, e em diferentes tipos de população


The main target of this study was to develop and validate an observation system of the environment in fitness group classes (SOCA-AGF), as well as to carry out a pilot implementation. A sample of 6 instructors from 2 activities (aquafitness and resistance training) with elderly people tested the functionality of the instrument. The observation system SOCA-AGF, which has 2 dimensions, 36 categories and 8 subcategories, showed reliability and validity. The results indicate that the observable behavior of fitness instructors in group classes can be codified by using this instrument. We concluded that the SOCA-AGF shows fundamental behavior aspects that influence the environment of the fitness instructor in group classes, therefore it can be used to study relevant aspects of the behavior that influences the class environment in different group activities, in the context of fitness and with different types of population


El presente estudio tuvo como principal objetivo desarrollar y validar un Sistema de Observación del Clima de Clase en Clases de Grupo de Fitness (SOCA-AGF), así como realizar una aplicación piloto del mismo. Para esta aplicación piloto se utilizó una muestra de 6 instructores de 2 actividades (hidrogimnasia y localizada), en población de tercera edad, para probar la funcionalidad del instrumento. Se verificó que el SOCA-AGF, constituido por 2 dimensiones, 36 categorías y 8 subcategorías, presentó fiabilidad y validez. Los resultados obtenidos indican que el comportamiento observable de los instructores, en clases de grupo, puede ser codificado recurriendo a este instrumento. Se concluyó que el SOCA-AGF registra aspectos fundamentales del comportamiento que influye en el clima de clase de los instructores de fitness en clases de grupo y, como tal, podrá ser utilizado para estudiar aspectos relevantes en el ámbito del comportamiento que influye en el clima de clase en diferentes actividades de grupo en el contexto del fitness y en diferentes tipos de población


Assuntos
Humanos , Técnicas de Exercício e de Movimento/instrumentação , Comportamento , Academias de Ginástica , Observação , Técnicas de Exercício e de Movimento/métodos
10.
BMC Health Serv Res ; 20(1): 338, 2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32316953

RESUMO

BACKGROUND: School going children across the world continue to experience high levels of untreated dental diseases. The South African Oral Health policy documents present measures to address the oral health needs of children in school settings, yet the burden of oral disease in the country is over 50% among primary school children. METHODS: Our study therefore sought to assess the implementation of school oral health programmes in Tshwane in line with policy recommendations using the Walt & Gilson policy analysis triangle. A qualitative explanatory case study was undertaken using a combination of data from direct observations and interviews. The case analysis involved assessing the processes of providing school oral health programmes that were offered at 10 schools in Tshwane. The measuring tools included process maps and an interview guide. RESULTS: The results found that policy implementation was affected by poor prior planning, inadequate resources, poor school infrastructure and lack of support from key stakeholders. Furthermore, inconsistencies in policy interpretation by management, coupled with the fact that the oral hygienists were not conversant with the policy hampered delivery of the policy content. The variations in policy implementation observed were often at the discretion of the oral hygienist in response to contextual challenges. CONCLUSION: There was policy and practice misalignment and variations in the processes of implementing oral health programmes across the 10 schools. Hence regular monitoring, evaluation and root cause analysis is recommended for such programmes in order to make informed decisions on contextually relevant and standardised programme modifications.


Assuntos
Política de Saúde , Promoção da Saúde , Saúde Bucal , Instituições Acadêmicas , Criança , Humanos , Entrevistas como Assunto , Observação , Formulação de Políticas , Pesquisa Qualitativa , Serviços de Enfermagem Escolar , África do Sul
11.
BMC Health Serv Res ; 20(1): 242, 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32293437

RESUMO

BACKGROUND: Hospital certification is an external assessment mechanism to assure quality and safety systems. Auditors representing the certification body play a key role in certification processes, as they perform the assessment activities and interact with the involved healthcare organizations. There is limited knowledge about the approaches and methods that auditors use, such as role repertoire, conduct, and assessment practice. The purpose of this study was to explore auditors' practice in hospital certification processes, guided by the following research questions: What styles do auditors apply in hospital certification processes, and how do auditors perceive their role in hospital certification processes? METHODS: The study was performed in two stages. In the first stage, non-participant observations (59 h) were conducted, to explore the professional practice of three lead auditors in certification processes of Norwegian hospitals. In the second stage, semi-structured interviews were conducted with these three observed lead auditors. The role repertoires and conducts identified were analyzed by using a deductive approach according to a surveyor (equivalent with auditor) styles typology framework. RESULTS: Two distinct auditor styles ("explorer" and "discusser") were identified among the three studied auditors. Both styles were characterized by their preference for an opportunistic and less structured type of interview practice during certification audits. All three auditors embedded a guiding approach (reflections about findings, stimulate improvements, experience transfer from other industries) to their perception and practice of certification audits, interacting with the auditees. The use of group interviews instead of individual interviews during certification audits, was the rule of their professional practice. CONCLUSION: The auditors' perceptions and styles demonstrated a multifaceted certification reality, in contrast to what is often presumed as consistent, stringent and independent practices. These findings may have implications for reliability judgements when developing hospital certification programs, and for the refinement of the current framework used here to study the different auditing practices.


Assuntos
Certificação/organização & administração , Hospitais , Humanos , Entrevistas como Assunto , Noruega , Observação , Pesquisa Qualitativa , Reprodutibilidade dos Testes
12.
J Neurosci ; 40(20): 3995-4009, 2020 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-32284337

RESUMO

Transcranial magnetic stimulation studies have highlighted that corticospinal excitability is increased during observation of object lifting, an effect termed "motor resonance." This facilitation is driven by movement features indicative of object weight, such as object size or observed movement kinematics. Here, we investigated in 35 humans (23 females) how motor resonance is altered when the observer's weight expectations, based on visual information, do not match the actual object weight as revealed by the observed movement kinematics. Our results highlight that motor resonance is not robustly driven by object weight but easily masked by a suppressive mechanism reflecting the correctness of weight expectations. Subsequently, we investigated in 24 humans (14 females) whether this suppressive mechanism was driven by higher-order cortical areas. For this, we induced "virtual lesions" to either the posterior superior temporal sulcus (pSTS) or dorsolateral prefrontal cortex (DLPFC) before having participants perform the task. Importantly, virtual lesion of pSTS eradicated this suppressive mechanism and restored object weight-driven motor resonance. In addition, DLPFC virtual lesion eradicated any modulation of motor resonance. This indicates that motor resonance is heavily mediated by top-down inputs from both pSTS and DLPFC. Together, these findings shed new light on the theorized cortical network driving motor resonance. That is, our findings highlight that motor resonance is not only driven by the putative human mirror neuron network consisting of the primary motor and premotor cortices as well as the anterior intraparietal sulcus, but also by top-down input from pSTS and DLPFC.SIGNIFICANCE STATEMENT Observation of object lifting activates the observer's motor system in a weight-specific fashion: Corticospinal excitability is larger when observing lifts of heavy objects compared with light ones. Interestingly, here we demonstrate that this weight-driven modulation of corticospinal excitability is easily suppressed by the observer's expectations about object weight and that this suppression is mediated by the posterior superior temporal sulcus. Thus, our findings show that modulation of corticospinal excitability during observed object lifting is not robust but easily altered by top-down cognitive processes. Finally, our results also indicate how cortical inputs, originating remotely from motor pathways and processing action observation, overlap with bottom-up motor resonance effects.


Assuntos
Antecipação Psicológica/fisiologia , Remoção , Percepção de Peso/fisiologia , Fenômenos Biomecânicos/fisiologia , Eletromiografia , Feminino , Humanos , Masculino , Neurônios-Espelho/fisiologia , Rede Nervosa/fisiologia , Observação , Córtex Pré-Frontal/fisiologia , Tratos Piramidais/fisiologia , Lobo Temporal/fisiologia , Estimulação Magnética Transcraniana , Percepção Visual/fisiologia , Adulto Jovem
14.
BMC Health Serv Res ; 20(1): 235, 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32192474

RESUMO

BACKGROUND: As diabetes prevalence rises world-wide, the arrangement of clinics and care packages is increasingly debated by health care professionals (HCPs), health service researchers, patient groups and policy makers. 'Integrated care', while representing a range of approaches, has been positioned as a promising solution with potential to benefit patients and health systems. This is particularly the case in rural populations which are often removed from centres of specialist care. The social arrangements within diabetes integrated care initiatives are understudied but are of particular importance to those implementing such initiatives. In this paper we explore the 'work' of integration through an analysis of the role played by Health Care Assistants (HCAs) who were specially trained in aspects of diabetes care and given the title 'Diabetes Care Technician' (DCT). METHODS: Using thematic analysis of interview (n = 55) and observation data (n = 40), we look at: how the role of DCTs was understood by patients and other HCPs, as well as the DCTs; and explore what DCTs did within the integrated care initiative. RESULTS: Our findings suggested that the DCTs saw their role as part of a hierarchy, providing links between members of the integrated team, and explaining and validating clinical decisions. Patients characterised DCTs as friends and advisors who provided continuity. Other HCPs perceived the DCTs as supportive, providing long-term monitoring and doing a different job to conventional HCAs. We found that DCTs had to navigate local terrain (social, ethical and physical), engage in significant conversation and negotiate treatment plans created through integrated care. The analysis suggests that relationships between patients and the DCTs were strong, had the quality of friendship and mitigated loneliness. CONCLUSIONS: DCTs played multidimensional roles in the integrated care initiative that required great social and emotional skill. Building friendships with patients was central to their work, which mitigated loneliness and facilitated the care they provided.


Assuntos
Prestação Integrada de Cuidados de Saúde , Diabetes Mellitus , Pessoal de Saúde , Pessoal Administrativo , Adulto , Idoso , Tomada de Decisões , Diabetes Mellitus/terapia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Observação , Participação do Paciente , Pesquisa Qualitativa
15.
BMC Med Educ ; 20(1): 64, 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131806

RESUMO

INTRODUCTION: Learners may subconsciously change their behavior once they know they are being observed, and this Hawthorne effect should be considered when designing assessments of learner behavior. While there is a growing body of literature to suggest direct observation is the ideal standard for formative assessment, the best method to directly observe learners is unknown. We explored scheduled and unscheduled methods of direct observation among internal medicine residents in the outpatient continuity clinic to advance the understanding of both observation methods. METHODS: We conducted a thematic analysis of faculty and internal medicine residents in an outpatient clinic setting. A semi-structured interview guide for focus group sessions was created. Focus groups were used to explore the internal medicine resident and core teaching faculty perceptions of the scheduled and unscheduled direct observation methods in the outpatient clinc. An experienced qualitative research interviewer external to the internal medicine residency was moderating the sessions. Eight peer focus groups were held. Abstraction of themes from focus group transcripts identified resident and faculty perceptions of the different observation methods. RESULTS: Focus groups had 14 resident participants and 14 faculty participants. Unscheduled observations were felt to be more authentic than scheduled observations since residents perceived their behavior to be unmodified. Unscheduled observations allowed for increased numbers of observations per resident, which permitted more frequent formative assessments. Residents and faculty preferred remote video observation compared to in-room observation. Participants found direct observation a useful learning tool for high-yield, specific feedback. CONCLUSIONS: Unscheduled remote direct observation captures authentic clinical encounters while minimizing learner behavior modification. An unscheduled observation approach results in more frequent formative assessment and therefore in more instances of valuable feedback compared to scheduled observations. These findings can help guide the best practice approaches to direct clinical observation in order to enhance residents learning and experience.


Assuntos
Instituições de Assistência Ambulatorial , Assistência Ambulatorial , Medicina Interna , Internato e Residência , Observação/métodos , Competência Clínica , Grupos Focais , Humanos , Medicina Interna/educação , Minnesota , Pesquisa Qualitativa
16.
BMC Med Educ ; 20(1): 66, 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32131812

RESUMO

BACKGROUND: Technology for minimal access surgery is rapidly progressing in all surgical specialities including Gynaecology. As robotic surgery becomes established in increasing numbers of hospitals, there is no set curriculum for training in robotic gynaecological surgery or the assistant role in use in the UK. The purpose of this study was to determine a list of competencies that could be used as the basis of a core robotic gynaecological surgery curriculum, to explore its acceptability and the level of interest in undertaking training in robotics among obstetrics & gynaecology (O&G) trainees. METHODS: A four-round Delphi study was conducted using members and associates of British & Irish Association of Robotic Gynaecological Surgeons (BIARGS). In Round 1 respondents were asked to propose standards that could be used in the curriculum. In the following three rounds, the respondents were asked to score each of the standards according to their opinion as to the importance of the standard. Items that scored a mean of 80% or above were included in the final proposed curriculum. Following this, a national survey was conducted to explore the interest among O&G trainees in undertaking a formal robotic training for the first assistant and console surgeon roles. RESULTS: The items proposed were divided into three separate sections: competencies for a medical first assistant; competencies for a console surgeon; continued professional development for trained console surgeons. From the national survey; 109 responses were received of which 60% were interested in undertaking a formal training for the first assistant role, and 68% are expressing interest in training for the console surgeon role. CONCLUSION: Undertaking a Delphi exercise to determine a core gynaecological robotic training curriculum has enabled consensus to be achieved from the opinions of BIARGS members/associates. There is interest among O&G trainees at all levels of training to gain experience and develop their skills in robotic surgery by undertaking a formal training in robotic surgery at both the first assistant and console surgeon level.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/educação , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos Robóticos , Currículo , Técnica Delfos , Feminino , Humanos , Observação , Inquéritos e Questionários
17.
BMC Health Serv Res ; 20(1): 78, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013980

RESUMO

BACKGROUND: Good workspace design is key to the quality of work, safety, and wellbeing for workers, yet we lack vital knowledge about optimal hospital design to meet healthcare workforce needs. This study used novel mobile methods to examine the concept of Work-as-Done and the effect of workspace-use on healthcare professional practice, productivity, health and safety in an Australian university hospital. METHODS: This pilot study took place in one gastroenterological surgical unit between 2018 and 2019. Data collection involved 50 h of observations and informal conversations, followed by interpretation of five architectural plans and 45 photographs. Fieldnotes were thematically analysed and corroborated by analysis of visual data using a predefined taxonomy. RESULTS: Six themes were identified, revealing spaces that both support and hinder Work-as-Done. Fit-for-purpose spaces facilitated effective communication between staff, patients and families, conferred relative comfort and privacy, and supported effective teamwork. Unfit-for-purpose spaces were characterised by disruptions to work practices, disharmony among team members, and physical discomfort for staff. Staff employed workarounds to manage unfit-for-purpose spaces. CONCLUSION: The results identified negative impacts of negotiating unfit-for-purpose workspaces on the work and wellbeing of staff. While the use of workarounds and adaptations enable staff to maintain everyday working practices, they can also lead to unexpected consequences. Results indicated the need to identify and support fit-for-purpose spaces and minimize the detrimental qualities of unfit-for-purpose spaces. This study showed that mobile methods were suitable for examining Work-as-Done in a fast-moving, adaptive hospital setting.


Assuntos
Eficiência Organizacional , Arquitetura Hospitalar , Recursos Humanos em Hospital/psicologia , Centro Cirúrgico Hospitalar/organização & administração , Local de Trabalho , Austrália , Hospitais Universitários , Humanos , Observação , Projetos Piloto
19.
PLoS One ; 15(2): e0228355, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32027683

RESUMO

A randomization test can be used to statistically test hypotheses in multiple baseline designs to complement the commonly used visual inspection analysis. A crossed factor simulation study was performed to investigate the power of a randomization test in an multiple baseline design. The results show that the degree of autocorrelation of the observations, the number of participants, the effect size, the overlap of possible start moments of the intervention between participants, the ratio of the number of measurements in the baseline- and intervention phase, a gradually emerging effect, and the number of measurements had strong main effects on the power. The two-way interactions between number of participants and effect size, and between the number of measurements and the number of start moments of the intervention also had a large effect. An online tool was developed to calculate the power of a multiple baseline design given several design characteristics.


Assuntos
Distribuição Aleatória , Projetos de Pesquisa , Estudos de Caso Único como Assunto/métodos , Biometria , Simulação por Computador , Estudos Cross-Over , Humanos , Observação , Exame Físico , Projetos de Pesquisa/normas , Projetos de Pesquisa/estatística & dados numéricos , Tamanho da Amostra , Estudos de Caso Único como Assunto/estatística & dados numéricos
20.
BMC Health Serv Res ; 20(1): 103, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041670

RESUMO

BACKGROUND: Authors in previous studies demonstrated that centralising acute stroke care is associated with an increased chance of timely Intra-Venous Thrombolysis (IVT) and lower costs compared to care at community hospitals. In this study we estimated the lower bound of the causal impact of centralising IVT on health and cost outcomes within clinical practice in the Northern Netherlands. METHODS: We used observational data from 267 and 780 patients in a centralised and decentralised system, respectively. The original dataset was linked to the hospital information systems. Literature on healthcare costs and Quality of Life (QoL) values up to 3 months post-stroke was searched to complete the input. We used Synthetic Control Methods (SCM) to counter selection bias. Differences in SCM outcomes included 95% Confidence Intervals (CI). To deal with unobserved heterogeneity we focused on recently developed methods to obtain the lower bounds of the causal impact. RESULTS: Using SCM to assess centralising acute stroke 3 months post-stroke revealed healthcare savings of $US 1735 (CI, 505 to 2966) while gaining 0.03 (CI, - 0.01 to 0.73) QoL per patient. The corresponding lower bounds of the causal impact are $US 1581 and 0.01. The dominant effect remained stable in the deterministic sensitivity analyses with $US 1360 (CI, 476 to 2244) as the most conservative estimate. CONCLUSIONS: In this study we showed that a centralised system for acute stroke care appeared both cost-saving and yielded better health outcomes. The results are highly relevant for policy makers, as this is the first study to address the issues of selection and unobserved heterogeneity in the evaluation of centralising acute stroke care, hence presenting causal estimates for budget decisions.


Assuntos
Serviços Centralizados no Hospital/organização & administração , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Serviços Centralizados no Hospital/economia , Custos e Análise de Custo , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Observação , Fatores de Tempo , Resultado do Tratamento
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